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Direct Oral Anticoagulants in Chronic Thromboembolic Pulmonary Hypertension: First Meta-Analysis of Prospective
Tang Zhang1, Linjuan Guo2, Shucheng Liang3
1Department of Cardiology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
Summary
Direct oral anticoagulants (DOACs) show similar effectiveness and safety compared to vitamin K antagonists (VKAs) in chronic thromboembolic pulmonary hypertension (CTEPH) patients. This systematic review suggests DOACs are a viable alternative for managing CTEPH.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Pharmacology
Background:
- Direct oral anticoagulants (DOACs) are increasingly used, but their role in chronic thromboembolic pulmonary hypertension (CTEPH) requires clarification.
- The safety and efficacy of DOACs versus traditional anticoagulants in CTEPH patients are not well-established.
Purpose of the Study:
- To systematically evaluate the safety and effectiveness of DOACs in patients diagnosed with CTEPH.
- To compare outcomes of DOACs with vitamin K antagonists (VKAs) in this specific patient population.
Main Methods:
- A systematic literature search was conducted on PubMed and EMBASE databases up to February 2024.
- Included studies comprised 2 randomized controlled trials and 2 prospective cohorts, totaling 2038 patients.
- Risk of bias and quality assessment were performed using Cochrane Risk of Bias Tool 2.0 and Newcastle-Ottawa Scale, respectively.
Main Results:
- No significant differences were observed in all-cause mortality (3.33% vs 3.33%) or VTE recurrence (1.46% vs 2.12%) between DOACs and VKAs.
- DOACs demonstrated a nonsignificant trend towards reduced bleeding events, including major bleeding (2.22% vs 3.71%) and any bleeding (5.33% vs 9.94%).
Conclusions:
- DOACs appear to be a safe and effective alternative to VKAs for anticoagulation in CTEPH patients.
- Further research may solidify the role of DOACs in managing CTEPH, potentially improving patient outcomes.
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